Active NPI
Elizabeth Dooshima Mabonga, MA, LPC
- Professional Counselor
- Austin, TX
National Provider Identifier
1619487022
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 74336
- Practice address
- 2501 W William Cannon Dr
Austin, TX 78745-5281 - Phone
- (512) 344-9181
- NPI assigned
- Oct 11, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 74336 | TX | Primary |
Addresses
Primary practice location
2501 W William Cannon Dr
Austin, TX 78745-5281
Mailing address
2104 Enfield Rd Apt D
Austin, TX 78703-3222
Phone (903) 312-0066
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 74336 | Other | TX | TEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 74336 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507680000000",
"number": "1619487022",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2104 ENFIELD RD APT D",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787033222",
"telephone_number": "903-312-0066"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2501 W WILLIAM CANNON DR",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787455281",
"telephone_number": "512-344-9181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MABONGA",
"first_name": "ELIZABETH",
"middle_name": "DOOSHIMA",
"credential": "MA, LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-11",
"last_updated": "2017-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "74336",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS",
"identifier": "74336",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.